Quite often, there is a need in clinical practice to remove the urinary bladder in men, women, and children, because of tumors, infections, neurologic abnormalities, or malformations. Bladder trauma is also very common after a car crash, a working accident, etc., and may require a cystectomy. Reconstruction of a new urinary bladder is common in urologic practice utilizing different segments of the intestine or of the stomach.
Two fundamental types of urinary neo-bladders allow patients to achieve urinary continence: the orthotopic neo-bladders where a patient voids through the penis, helping himself with the contraction of the abdominal musculature, and, as under normal conditions, continence is achieved with the natural sphincter; and neo-bladders with a stoma in which the neo-bladder, fashioned with a continence mechanism, communicates with the abdominal wall, and the patient catheterizes himself through the stoma to void regularly.
Common post-operatory catheters utilized for the drainage of neo-bladders are the same bladder catheters in use for many years to drain the natural bladder for the elderly, surgery of the prostate, endoscopic or partial surgery of the bladder, etc. A bladder (urethral) catheter is usually made of different materials (latex rubber, polyvinyl, polyurethane, co-polymer, silicone rubber, etc.), in different shapes and dimensions. These types of catheters are in wide use all over the world and do not show particular, technical difficulties. The balloon that anchors the catheter is made of the same rubber-elastic material in different sizes and volumes, depending on final requirements, and can be inflated or deflated through a continent valve inserted tangential to the funnel of the catheter; the balloon can be fused to the catheter or simply fixed on it, depending on the technique.
The tip of a bladder catheter is very short, about 3 cm.
Using the intestine in reconstructing the bladder, the intestinal mucosa frequently causes obstructions of the catheter by producing mucous secretions and mucous clots, with the risk of dangerous passive over distensions of the neo-bladder. The nurse personnel and the doctors must frequently wash the neo-bladders through the catheter during the two weeks of post-operatory period.
It is usually not possible to maintain a continuous washing flow through the catheter in the post-operatory period, because sudden and inadvertent obstructions not recognized immediately by the medical and nursing staff, could cause a dangerous over distension of the newly fashioned bladder and a possible rupture. Moreover, when a portion of the stomach has been utilized in reconstructing the bladder, a particular surgical procedure suitable for children, the mucosa of the portion of the stomach, utilized in the reconstruction, produces chloric acid, digestive enzymes, and mucous.
Medical therapy adequately cannot prevent the secretion of chloric acid that is sometimes responsible for severe bleeding from the mucosa (gastric) of neo-bladders. This is a common complaint for a few months after the neo-bladder procedure.